乙肝相关性肾炎的治疗

Treatment for hepatitis B virus associated glomerulonephritis

乙肝相关性肾炎(HBV-GN)临床上常见。HBV-GN具有免疫复合物介导损伤基础,可根据其临床和病理表现进行免疫抑制治疗。对于有HBV复制或肝炎活动的肾炎患者,同时需使用抗病毒治疗。免疫抑制治疗药物如糖皮质激素能促进HBV-GN的缓解;吗替麦考酚酯联合激素对HBV-GN有确切疗效。抗病毒药物如IFN-α对HBV-GN可能有益,尤其对儿童及非流行区成人患者,但对流行区成人患者则几乎无效;拉米夫定抗病毒作用肯定,为免疫抑制治疗时预防用药;对拉米夫定耐药病毒可用阿德福韦治疗,但其对肾炎或肾功能不全患者的影响有待研究;恩替卡韦和替比夫定抗病毒疗效优于对拉米夫定。中医药接合症候治疗有效。

Hepatitis B virus associated glomerulonepbritis （HBV-GN） are clinically common. HBV-GN has an immunocomplex-mediate-lesion base. Immunosuppressive therapy could be applied according to different pathologic and clinical manifestations in glomerulonephritis patients. Those patients who have active hepatitis or signs of HBV replication need antivirus therapy. The immunosuppression treatment medicine like sugar cortical hormone can promote the HBV-GN alleviation. Mycophenolate Mofetil treating HBV-GN combined with steroid has positive effect. Antivirus medicine such as IFN-α could be efficient to HBV-GN, especially to child and non popular area adult patient, but the convection zone adult patient nearly is invalid; Lamivudine has definitely antivirus activity and is used as prevention while patients need immunosuppressive therapy. Adefovir might be applied to Lamivudine-tolerant-virus infection, but its effect on nephritis or the kidney functions need studying. Entecavir and Telbivudine are effective than Lamivudine in antivirus . The Chinese traditional medicine joint symptom treatment is effective.